SELF-EVALUATION FORM

This form can be used in lieu of conducting a Self-Assessment based upon specific
performance expectations. This form can be used to generate discussion about general
aspects of the job.
Name: _____________________________ Date: _____________________________
Title: ______________________________ Department: _______________________
Review Period: ______________________
Please complete the questions listed below and return to your supervisor prior to your
performance evaluation. As you complete the form, consider your own personal
performance as it relates to your current job description and expectations for the review
period.
1. Do you understand the requirements of your job?
If no, what aspects of your job need clarification?

Yes ___

No ___

2. List the expectations for the review period and assess how well you have succeeded in
meeting
each expectation. Attach a separate sheet if necessary.

3. What changes in duties or priorities did you face during the review period and how did
you handle them?

4. What are your strengths (the things you do well) and how do you put them to use in your
position?

5. What are your weaknesses (the things you dont do so well) and how do they impact your
job?

6. What would help you enhance your performance (training, equipment, etc.)?

7. What are your expectations for the coming evaluation period?

8. How would you rate your overall performance for this review period?
Outstanding ___ Exceeds Expectations ___
Meets Expectations ___ Below Expectations ___
Unsatisfactory ___